Category: Health/Medicine News

Breast cancer treatments have come a long way in recent decades, but understanding how to prevent tumors from forming in the first place has been a major challenge.

In a new study being presented at the annual American Society of Clinical Oncology meeting in Chicago next month, researchers report intriguing evidence that a low-fat diet, similar to the kind doctors recommend for heart health, is also linked to a lower risk of dying from breast cancer.

The study analyzed data from the Women’s Health Initiative, a large trial sponsored by the National Institutes of Health that studies the health effects of hormone therapy, diet and certain supplements on the health of more than 160,000 postmenopausal women. In this trial, researchers led by Dr. Rowan Chlebowski, an investigator at LA Biomedical Research Institute at Harbor-UCLA Medical Center, focused on a group of nearly 49,000 women who were randomly assigned to follow either a low-fat diet or a control diet for 8.5 years. The low-fat diet group aimed to reduce their fat intake to 20% of their total daily calories and to increase the consumption of fruit, vegetables and grains. None of the women had breast cancer at the start of the study.

After the study ended, the rates of new breast cancers were about the same in the two groups, but women who were diagnosed with breast cancer in the interim had a 35% lower risk of dying from any cause compared to those on the control diet. Even 20 years after the study ended, the women who ate the low-fat diet continued to have a 15% lower mortality risk. And in the longer follow-up data, their risk of dying specifically from breast cancer was 21% lower than that of the women who didn’t change their diet.

“This is a very exciting result for us,” says Chlebowski. “Now we have randomized clinical trial evidence that dietary moderation, which is achievable by many, can have health benefits including reducing risk of death from breast cancer. That’s pretty good; it’s hard not to be happy about that.”

The study is the first to rigorously test a potential factor that could influence deaths from breast cancer. Earlier observational studies did not assign volunteers to specific diets but looked at cancer outcomes depending on what people, on their own, chose to eat. In this study, volunteers were provided with dietary guidelines to follow about what to eat. “Until this study, we lacked any data from a prospective randomized control trial, which is the gold standard, for showing that a dietary approach really does reduce the risk of dying from breast cancer,” says Dr. Neil Iyengar, a medical oncologist at Memorial Sloan Kettering Cancer Center, who was not involved in the study. “Many of us who are proponents of considering diet and exercise in the cancer treatment plan are excited by this trial data because it is the first to show in a very robust way that we can improve outcomes and prevent cancer-related deaths just by changing the diet.”

In a separate sub-study, the research team also showed that the longer women were on the modified diet, the lower their risk of death during the study period. The results should give doctors more confidence in considering diet when discussing treatment options with women who are diagnosed with breast cancer. While the study did not find a significant connection between dietary changes and the incidence of new breast cancer, the results do suggest that modifying the diet can lower a woman’s risk of dying from any cause, or from breast cancer, if she is diagnosed with the disease.

The reason for that, says Iyengar, may have to do with the diet’s “dose.” It’s possible, for example, that the effect of the dietary change is greater on tiny tumors in the breast tissue that are already established, although they aren’t robust enough yet to lead to a diagnosis of breast cancer. “The effect of this diet may be stronger in preventing the growth of already established tumors rather than preventing the development of tumors,” he says. “What this trial does is position us to take a deeper dive, now that we know we can effectively change the tumor or cancer behavior with diet.”

Chlebowski plans to dig deeper into the data to find out more about how diet is working to lower deaths from breast cancer. During the trial, women provided blood samples both at the start of the study and one year later, so he and his team may find factors that changed among the women on the diet compared to those on the control plan.

In the meantime, he hopes cancer doctors will talk about diet with their patients who might be at higher risk of developing breast cancer. Though not all women in the study were able to lower their fat intake to 20% of their daily calories,“these dietary changes are achievable by many,” he says. Even though not all of the women on the low-fat diet met the target, the study showed that the modifications still reduced risk of dying from any cause and from breast cancer. “It’s about taking smaller pieces of meat, and adding vegetables to the plate to balance things out,” he says.

Doctors have gotten much better at detecting and treating breast cancer early. Drug and chemotherapy regimens to control tumors have gotten so effective, in fact, that in some cases, surgery is no longer necessary. In up to 30% of cases of early-stage breast cancer treated before surgery, doctors can’t find evidence of cancer cells in postoperative biopsies. The problem, however, is that there is currently no reliable way to tell which cancers have been pushed into remission and which ones have not.

That’s where an easy identifier, like a blood test, could transform the way early stage breast cancer is treated. In a paper published in Science Translational Medicine, researchers led by a team at the Translational Genomics Institute (TGen), an Arizona-based nonprofit, report encouraging results on just such a liquid biopsy. Its test, called Targeted Digital Sequencing (or TARDIS), was up to 100 times more sensitive than other similar liquid-biopsy tests in picking up DNA shed by breast cancer cells into the blood.

Currently available ways of tracking breast cancer cells in the blood are most useful in people with advanced cancer. In those conditions, cancer cells litter the blood with fragments of their DNA as they circulate throughout the body to seed new tumors in other tissues like the bone, liver and brain. But in early-stage breast cancer, these cells are, by definition, scarcer.

To address the problem, the research team, which included scientists at Arizona State University, the City of Hope, Mayo Clinic, and the Cancer Research UK Cambridge Institute, developed a new way to pick up elusive cancer DNA. They genetically sequenced tumor biopsy tissue from 33 women with stage 1, 2, or 3 breast cancer, most of whom received drug or chemotherapy treatment prior to getting surgery to remove their tumors. By comparing the tumor sequence to the sequence from the patients’ normal cells, the scientists isolated potential mutations that distinguished the cancer cells and identified those that were most likely to be so-called “founder mutations”—genetic aberrations present in the original cancer cells and carried into the resulting tumor.

On average, each patient harbored about 66 such founder mutations. For each patient, the scientists combined the founder mutations to form a personalized assay, which could then be used to pick up signs of breast cancer DNA in blood samples. Combining a number of mutations together turned out to be a more sensitive way to detect tumor DNA than trying to pick up a single or a small number of mutations in an already small number of tumor DNA fragments present in the blood.

They combined this approach with a new strategy for amplifying the scarce tumor DNA found in a blood sample by preserving the size of these snippets and attaching unique molecular identifiers to them to make them more easily detectable.

At the start of the study, TARDIS was able to find tumor DNA in the blood samples of all the patients; other liquid biopsies for breast cancer currently in development have reported picking up 50% to 75% of the cancer cases.

After the pre-surgery treatment TARDIS detected circulating tumor DNA in the blood in concentrations as low as 0.003%, or 100-fold more sensitive than other tests being developed.

“This is an important advance,” says Dr. Debu Tripathy, professor and chair of the breast medical oncology department at the University of Texas MD Anderson Cancer Center, who was not involved in the study. “This test can help identify those with early stage breast cancer who may still have residual cancer in their body that may not be detectable with standard scans.”

That could help guide treatment, by, for example, determining which patients require closer monitoring for recurrent growths. Because the sequencing identifies the genetic mutations contributing to the tumor, the test could also help doctors to decide which targeted drug therapies, which are designed to address specific cancer mutations, to prescribe for their patients.

Most importantly, the test could help women whose tumors are effectively eliminated by their pre-surgery treatment to avoid an operation altogether since the blood test would reassure her and her doctor that no residual tumor DNA remained.

“If we could really know with a more accurate degree of certainty that you don’t have residual disease, it would be help in saying that you don’t need any more therapy [including surgery],” says Dorraya El-Ashry, chief scientific officer of the Breast Cancer Research Foundation. ”Conversely, if you still had residual disease, if there is information from the test that can pinpoint the next therapy, that would also be better.”

Muhammed Murtaza, co-director of the center for non-invasive diagnostics at TGen, says TARDIS needs to be tested in a larger group of breast cancer patients before it can be rolled out to doctors’ offices. His team is planning to study the test’s efficacy in about 200 breast cancer patients, in order to clarify exactly what levels of tumor DNA found in the blood are most likely to lead to recurrence. They are also exploring how modified versions of TARDIS could be applied to other cancers, like esophageal, colorectal, pancreatic and prostate.

There’s even encouraging precedent for this sort of a liquid biopsy. Doctors routinely rely on a blood test for chronic myeloid leukemia, for example, to track patients’ response to targeted drugs that treat specific mutations driving the cancer. “Applying this same technology to more common solid cancers like breast cancer is the new frontier,” says Tripathy.

Caffeine can be both a treatment and a trigger for migraine headaches, which makes it difficult for sufferers to know how much to sip. Experts believe caffeine helps block adenosine, a molecule involved in migraine attacks, from binding to receptors in the brain, so many people use it as an at-home remedy; it’s also an ingredient in many over-the-counter migraine drugs. But, counter intuitively, some migraine sufferers also say consuming caffeine can bring on their debilitating headaches.

“The complex thing with caffeine is sometimes it’s harmful and sometime it’s beneficial,” says Elizabeth Mostofsky, a cardiovascular epidemiology researcher at Beth Israel Deaconess Medical Center in Boston. “It really amounts to the dose and the frequency of having it.”

Mostofsky is a co-author on a new study published in the American Journal of Medicine that helps define that risk-benefit balance. The findings suggest that having three servings of caffeinated beverages such as coffee, tea and soda in a day seems to be the tipping point at which caffeine becomes a possible migraine trigger. (A serving is typically defined as eight ounces of coffee, six ounces of tea, 12 ounces of soda or two ounces of an energy drink. While caffeine content can vary from drink to drink, the study did not distinguish between types of caffeinated beverages.)

For the study, researchers asked 98 adults who suffered two to 15 migraines per month to log their caffeine consumption twice a day for six weeks, along with information about other possible migraine triggers including exercise, alcohol consumption, mood, sleep, menstrual status and weather changes. They also provided information about the symptoms of migraines they suffered during the study period, and how they treated them. Participants also provided their demographic and medical histories. Most of them, like most U.S. migraine sufferers, were female.

After adjusting for other potential triggers, the researchers noticed an inflection point around three servings of caffeine per day. One or two caffeinated beverages per day wasn’t statistically associated with a higher chance of migraine, but downing three or more was linked to a higher risk of headaches both on that day and the one following, the researchers found.

The fact that the correlation applied to the day after high-caffeine consumption is especially telling: Many migraine sufferers use caffeine as a treatment for existing headaches, but the fact that people were more likely to have headaches the day after heavy caffeine consumption suggests that the drinks were causing, not treating, migraines, Mostofsky says.

Mostofsky notes that an individual’s tolerance to caffeine, which can build over time, likely matters too. For example, in this study, people who said they typically had less than one serving of caffeine per day saw a higher risk of migraine on days that they drank even one or two caffeinated beverages. The reverse may be true, too. Plenty of evidence shows that people who are heavy caffeine users can experience headaches, migraine or otherwise, if they miss their daily dose.

The study did not look at which types of caffeinated beverages were most strongly associated with headaches. And since the study was observational, meaning it looked only at patterns reflected in the data, Mostofsky says she can’t prescribe the perfect amount of caffeine. Nonetheless, she says migraine sufferers should keep these findings in mind the next time they’re at the coffee-shop counter.

If you were walking down the street and a man fell to the pavement clutching his chest, would you know what to do? According to a recent study, of 19,331 out-of-hospital cardiac arrests, there’s a 45 percent chance that someone would rush forward to give the man the CPR he needs.

Important follow-up question: if you were walking down the street and a woman fell to the pavement clutching her chest, would you know what to do? The same study showed that a woman is 27 percent less likely than a man to get CPR from a bystander in public. While there isn’t enough research on the intersecting factors of gender and race, studies looking at race and gender separately suggest that women of color are even less likely to receive bystander CPR.

As half a million Americans will die from cardiac arrest annually, timely CPR is an incredibly important matter. Even as major health organizations train tens of millions of people in resuscitation techniques each year, women still lack equal access to the lifesaving compressions of CPR.

It’s important to look at why bystanders are so much less likely to intervene to save a woman in cardiac arrest. The first barrier is a wildly inaccurate myth that women don’t even experience cardiac arrest. Though many people think heart issues are a “men’s problem,” heart disease actually affects more women than men, killing roughly one woman every minute. Even when bystanders accurately identify that a woman needs CPR, they may be afraid to touch her breasts, confused about where to put their hands, or apprehensive about pushing down hard and fast on a woman’s body.

So, how do we address this laundry list of misconceptions that are literally killing women? The same way we popularized the resuscitation techniques that remarkably double or triple cardiac arrest victims’ chances of survival: through education.

Noticing this shocking oversight, an equal parts pissed-off and inspired team at JOAN Creative had an idea—the WoManikin.

Imagine a CPR manikin (the medical term for the dummies used in training courses), that expressionless, universal human form meant to represent everybody and anybody who could suffer cardiac arrest. See something missing from the manikin’s body? Or rather, two things?

Noticing this shocking oversight, an equal parts pissed-off and inspired team at JOAN Creative had an idea—the WoManikin. The WoManikin is a universal attachment that can easily be slipped over the common flat-chested manikin to add breasts. The WoManikin teaches people how to perform CPR on a torso with breasts during training, so they’ll know what to do when they see a woman or person with breasts in cardiac arrest.

By putting the sleeve design on WoManikin.org as an open source pattern and starting a fund to create more attachments, JOAN hopes to get a WoManikin in every CPR training program in the country by 2020. JOAN developed the WoManikin in collaboration with CPR experts, cardiologists, and organizations that care about closing the gender gap in CPR. So, in that way, the WoManikin doesn’t just provide a way to challenge biased CPR training—it shows what happens when women collaborate and apply creativity to tackle the inequities around them.

To learn more and join the fight to end gender disparities in CPR, visit WoManikin.org.

The landscape of experimental Alzheimer’s disease (AD) drugs is strewn with failures, so much so that it has been referred to as “an unrelenting disaster zone”. Recognizing the greatly increasing number of patients with this disease, many biopharma companies have invested a lot of resources in attacking this problem, only to be turned away in late stage studies as happened to Merck with its BACE inhibitor, verubecestat, and Lilly with its beta-amyloid antibody, solanezumab.

Now add Biogen to the list of companies that have failed in this arena. Its drug, aducanumab, partnered with Eisai, was believed to be better in removing beta-amyloid from the brain than any agent previously tested. Many have hypothesized that beta-amyloid causes the formation of damaging clumps of debris in the brain leading to AD. Unfortunately, Biogen halted a major clinical trial with aducanumab due to a futility analysis showing that the drug doesn’t work.

This is a terrible result for Alzheimer’s patients who had hoped that this was the drug that would finally succeed in treating AD. But the demise of aducanumab is also disastrous for Biogen which had expended an enormous amount of resources into this program, likely at the expense of other opportunities. It was a risky bet and one for which Wall Street has delivered a punishing blow. Biogen’s stock dropped by nearly 30% shortly after announcing the disappointing aducanumab results.

How is Biogen going to respond? As John Carroll has reported, many industry analysts believe that there aren’t many gems in the Biogen pipeline that can make up for the loss of this potential blockbuster. In predicting Biogen’s next steps, perhaps there are some learnings from another such pipeline failure – that of Pfizer’s torcetrapib.

Torcetrapib was the first of a class of compounds known as CETP inhibitors, drugs that both raised HDL-cholesterol and lowered LDL-cholesterol. A CETP inhibitor had the potential to remodel a heart patient’s lipid profile thereby greatly reducing his risk of a heart attack or stroke. There was tremendous excitement generated in this potential breakthrough treatment, not just in Pfizer but also among cardiologists and heart patients. In fact, internal commercial analyses predicted annual sales in excess of $15 billion. However, as happened with aducanumab, on December 4th, 2006, Pfizer announced that torcetrapib failed its long-term clinical study. The drug was dead. The Wall Street reaction was swift, albeit not as dramatic as Biogen’s experience. Pfizer stock dropped 10% as a result of this news.

Skills-based Hiring Goes Coast-to-Coast

Internally, the Pfizer reaction was intense. Torcetrapib was supposed to be the blockbuster that would drive growth into the next decade. Its loss created an enormous hole. Pfizer CEO Jeff Kindler responded in a couple of ways. First, he decided to “right size” R&D in relation to lower expected future revenues. In effect, hundreds of millions of dollars needed to be cut from R&D. Pfizer’s R&D budget had already undergone major portfolio adjustments and reorganizations over the previous five years due to the acquisition of Warner-Lambert Parke-Davis in 2000 followed by the acquisition of Pharmacia in 2004. Meeting the new R&D budget targets weren’t going to be achieved by simple cuts; rather, major research sites had to be closed and jobs had to be eliminated. Gone were R&D sites around the world including those in France, Japan and, most significantly, the iconic laboratory in Ann Arbor, Michigan.

But budget cuts weren’t going to be enough for Pfizer to meet its desired goals. The company began assessing major M&A opportunities and in 2009 it acquired Wyeth for $68 billion leading to yet another round of reorganizations and portfolio reshuffling. The ripple effect of the torcetrapib demise was felt by the entire company and lasted for a number of years.

So, how will Biogen respond? Undoubtedly, there will be budget cuts. In addition, perhaps Biogen will look at its R&D portfolio and give a higher priority to those programs that have the potential to deliver revenues in the short term. There might also be a push to drop programs deemed to be very risky or where the proof-of-concept requires long, expensive clinical trials. Finally, it wouldn’t be surprising to see Biogen become aggressive in their M&A activities. But make no mistake. The death of an important drug like aducanumab will have both a short and a long term effect on Biogen as a company and especially on R&D.

Imagine undergoing surgery on a robotic bed that can automatically help perform a magnetic resonance imaging (MRI) scan while an artificial intelligence (AI) system actively supports surgeons by suggesting various procedures. It sounds like a scenario from a Hollywood movie, but it’s reality in Japan.

Doctors at the Tokyo Women’s Medical University – Waseda University Joint Institution for Advanced Biomedical Sciences (TWIns) recently performed a groundbreaking brain surgery to treat essential tremor, a neurological disorder. It was the first clinical use of the latest version of the institution’s Smart Cyber Operating Theater (SCOT). Hyper SCOT, as it’s known, brings robotics and AI into the operating theater so that patients can have better post-surgical outcomes. It’s an impressive example of the many forms of open collaboration driving innovation in Japan.

A new frontier in surgery

Walking into the Hyper SCOT operating room at Tokyo Women’s Medical University, one gets the feeling of entering Sick Bay aboard the starship Enterprise from Star Trek. Silver doors slide open to reveal a sleek white room illuminated by variable-color lights. In the center are a pair of robots: an operating bed that swivels to position a patient under a large MRI scanner nearby, and a dual-armed industrial-style robot that can support a surgeon’s arms while operating. On the wall are high-resolution images of a patient’s brain. Surgeons can gesture to zoom in or change the images’ orientation, a feature inspired by the Tom Cruise film Minority Report.

Hyper SCOT is designed to transform surgery from an analog process, where standalone equipment is not connected, into a digital process where data are shared. It can support surgical teams by providing them with a rich stream of data from networked medical tools as well as AI-powered advice on surgical options. SCOT also aims to improve precision by helping brain surgeons accurately navigate to a tumor site. Although MRI had only been available to surgeons before an operation, Hyper SCOT would enable them to get scans during the procedure, which could dramatically improve outcomes.

“If we have many kinds of information, we need some kind of strategy desk, like Mission Control at NASA,” says SCOT project leader Yoshihiro Muragaki, a professor in Tokyo Women’s Medical University’s Institute of Advanced Biomedical Engineering and Science. “Our moonshot is to make new eyes, brains and hands for surgeons. With SCOT, we can perform precision-guided therapy.”

A neurosurgeon himself, Muragaki conceived of the SCOT project and has spearheaded it since its inception in 2000. Back then it was known as the Intelligent Operating Theater, a version now known as Classic SCOT. Supported by a grant from the Japan Agency for Medical Research and Development (AMED), the system began as an initiative to enhance interoperability among devices used in the medical theater, but the development team later added features such as multiple surgery cameras that can send imagery to remote consultants, usually senior surgeons. These advisors have a bird’s-eye view of the action as well as near-real time data streams of patients’ vital statistics. Since 2000, the technology has been used in some 1,900 cases, mostly brain surgeries. MRI has been key in detecting residual tumor tissue that escaped surgeons’ notice during operations.

“Even under a microscope, it’s very difficult to detect where brain tumor tissue ends and healthy tissue begins,” says Muragaki. “That’s why we need MRI during surgery. It’s a very powerful tool for removing tumors. But that also means we can only use MRI-compatible devices in the operating room and we must choose them carefully.”

Fruits of teamwork

With over 100 researchers, SCOT is the result of a complex collaboration between academia and the private and public sectors. Aside from the two universities in TWIns, Muragaki and colleagues are working with Hiroshima University and Shinshu University, where versions of SCOT are being evaluated in clinical settings. High-tech companies are also helping to develop SCOT, including Hitachi, Canon Medical, and Air Water. Another participant is Denso. It developed a medical-equipment middleware called OpeLiNK that is based on factory automation technology as well as ORiN, a platform created with the support of the New Energy and Industrial Technology Development Organization (NEDO), a leading Japanese state-backed research center. Orchestrating all these players was essential in creating SCOT.

Another major benefit of SCOT is the ability to obtain scans using an MRI machine (right) during surgery. JAPAN BRANDVOICE

“If one company tried to do this alone, it would want to use its own technology and keep rivals out,” says Muragaki. “That company wouldn’t succeed in integrating all the various technologies. That’s why public institutions are vital for this kind of open innovation project. They act like the frame in a traditional sensu Japanese folding fan, keeping everything together as the project unfolds.”

The collaborations that gave birth to SCOT were recently recognized when it picked up the Minister of Health, Labour and Welfare Award as part of the first Japan Open Innovation Prize. Sponsored by the Japanese government, the accolade was set up to promote initiatives that can serve as future role models for open innovation. In Japan, companies traditionally kept R&D in-house, even in recent years. But the public and private sectors have been pushing open innovation as a vehicle for enhancing competitiveness. Collaborations between government labs, corporations and universities are now flourishing. Major telecom carrier KDDI, for instance, launched the first of a series of Open Innovation Funds in 2012, aimed at investing in IT startups in Japan and overseas.

“There’s a growing recognition that if a company categorizes itself as a camera company, for instance, it is limiting itself,” Keiichiro Koumura, an official with major real estate company Mitsui Fudosan, recently told attendees at an open innovation seminar at Mitsui Fudosan’s Base Q in Tokyo. “Because as technology changes, cameras have become smartphones. One way to address this is open innovation.”

As for SCOT, Muragaki hopes to spread the technology to other hospital facilities such as intensive care units, and apply it to other forms of surgery such as vascular operations. He also hopes to take the technology overseas.

“Most doctors are resistant to change. Before they try SCOT, surgeons don’t regard it as something that’s necessary but once they give it a go, their view changes,” says Muragaki. “After brain surgeries, we want to try the technology on bone tumors, and keep going. If you could do all surgeries with SCOT, it would decrease risks and increase benefits. That’s something we can work toward.”

One of my favorite sources for information on the microbiome is run by Dr. Peter J. D’Adamo. For many years he has advocated eating for your blood type. In this week’s issue of New Scientist. an article “Your gut bacteria may match your blood group – but we don’t know why“ The difference between many […]

HLA mismatches and the production of alloantibodies HLA mismatches are not only the trigger for alloreactive T cells to destroy the transplant parenchyma, they also lead to the formation of alloreactive anti-HLA antibodies; and together they contribute to acute and chronic rejection, and the eventual immunologically-mediated transplant loss. But it is not the number […]

As the story goes, nearly 80 years ago on the Faroe Islands — a stark North Atlantic archipelago 200 miles off the coast of Scotland — a neurologic epidemic may have washed, or rather convoyed, ashore. Before 1940 the incidence of multiple sclerosis on the Faroes was near, if not actually, zero, according to the tantalizing lore I recall from medical school. Yet in the years following British occupation of the islands during World War II, the rate of MS rose dramatically, leading many researchers to assume the outbreak was caused by some unknown germ transmitted by the foreign soldiers……..

Low iron is the most common and widespread nutritional disorder in the world, and is the only nutrient deficiency that is significantly prevalent in the western world, according to the World Health Organization. A staggering 2 billion people (that’s over 30 per cent of the world’s population) are thought to suffer from some degree of iron deficiency. And it’s especially common in women, specifically those of childbearing age. So chances are, you’re low in it too………